Deep phenotyping neuropathy: An underestimated complication in patients with pre-diabetes and type 2 diabetes associated with albuminuria

• Published in: Diabetes research and clinical practice Vol. 146; pp. 191 - 201
• Main Authors: Kopf, Stefan, Groener, Jan B., Kender, Zoltan, Fleming, Thomas, Bischoff, Sandra, Jende, Johann, Schumann, Carsten, Ries, Stefan, Bendszus, Martin, Schuh-Hofer, Sigrid, Treede, Rolf-Detlef, Nawroth, Peter P.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2018
• Subjects: Albuminuria - complications; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - pathology; Diabetic Neuropathies - complications; Diabetic neuropathy; Female; Humans; Male; Middle Aged; Nerve fiber function; Pre-diabetes; Prediabetic State - complications; Prediabetic State - pathology; Type 2 diabetes; Type 2 diabetes; CPT; VDT; Diabetic neuropathy; Nerve fiber function; TSL; HPT; DPNP; NSS; MPT; MPS; CDT; QST; PPT; WUR; Pre-diabetes; DMA; PHS; MDT; NDS; NCS
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2018.10.020

The aim of the study was to assess whether quantitative-sensory-testing could be used to evaluate prevalence and predictors of diabetic neuropathy (DPNP) in patients with pre-diabetes and type 2 diabetes. Twenty-eight pre-diabetics and 108 patients with type 2 diabetes were evaluated using neuropathy-deficit-score (NDS), neuropathy-symptom-score (NSS), nerve-conduction-studies (NCS), short-QST-protocol to examine small fibers and the comprehensive QST-battery (long-QST) according to the German Research Network on Neuropathic Pain protocol. Long-QST revealed a DPNP-prevalence of 71% in pre-diabetics and 95% in patients with type 2 diabetes, while according to NDS it was only 11% and 63%, and NCS missed 58% of patients with DPNP. Small and medium fibers were similarly affected in both groups, while large fiber deficits were significantly more common in type 2 diabetes (p < 0.01). Complete loss of function in all fibers was significantly higher in patients with type 2 diabetes than in pre-diabetics (26% vs. 11%, p < 0.05). Hyperalgesia was slightly increased in pre-diabetes than in type 2 diabetes (57% vs. 43%, p = n.s.). However, NSS only showed significant associations with large fiber deficits. Logistic regression analyses revealed that age (OR 1.14[1.05/1.24]) and albuminuria (OR 12.8[1.52/107.3]) were independent predictors for the presence of DPNP. DPNP is much more prevalent in patients with pre-diabetes and type 2 diabetes and clinical routine tests may miss the majority of affected patients. Age and albuminuria, but not HbA1c, appear to be significantly associated with DPNP. Clinical Trial Registration: NCT03022721.